Baltimore VA focuses on breast cancer services to meet demand

The rise in the number of female military veterans has led the Baltimore Veterans Affairs Medical Center to update its breast cancer care options to meet the growing demand.

"Females are the fastest-growing demographic of veterans," said Dr. Ajay Jain, chief of surgical oncology at the Baltimore VA. "This is something we've really become aware of over the last five to 10 years."

The hospital performed 7,355 mammograms between 2000 and 2013, according to a recent report, with the bulk of them, 6,270, occurring after 2008. Jain said the numbers drastically increased after 2008 as a result of an effort on the part of the hospital to expand and promote breast cancer screenings.

Because of the rise in eligible patients, the Baltimore VA had adjusted its practices to enable its staff to perform more mammograms. But the changes also led to delays in treatment and patients using alternate facilities for follow-up care after receiving the results of their mammograms, VA researchers said in the report published in mid-September in JAMA Surgery.

The authors of the study suspected the higher number of patients had caused the time between the initial diagnosis and the start of treatment to grow from 33 days to 51 days between 2008 and 2012.

To address the issue, Jain, who helped conduct the study, said plans are underway to expand and promote breast cancer screening options at the Baltimore VA.

The hospital has acquired new, faster technology to curb the delays caused by the increased volume of patients receiving treatment. In December 2012, the medical center became the first in the state to offer three-dimensional mammography.

The 3-D mammograms provide more detailed imagery of breasts, showing multiple layers of tissue instead of a mass, said Dr. Rakhi Goel, director of breast imaging at the center. The scans enable earlier and clearer detection of potential cancer cells, which reduces the amount of time the patient must spend in the screening process.

"It has been a major improvement to offer that," said Goel, who was hired as a breast cancer specialist for the VA as part of the changes that began in 2008. The medical center also began employing "navigators," who work to coordinate and expedite appointments for the patients at all appropriate treatment facilities.

Cate Conroy, a 50-year-old Army veteran who served from 1989 to 1992, was among the first to use the 3-D breast cancer screening system. The Baltimore woman has been a patient at the VA for 10 years and has mammograms performed annually.

"The images were very high quality, so there's less likelihood that I have to come back," she said. "The more accessible preventive health care can be, the more people will take advantage."

Tomasina Pena, 58, has noticed the new attention being paid to women's health.

"Before, most of the service was male-oriented," she said. "They realized all of these women are retiring and they need services that apply specifically to women."

Pena has been a patient at the VA since 2003, when she retired from the Air Force after 22 years of service. She has been receiving care at the hospital more frequently in recent years, after medical staff discovered calcification in her breasts.

The Dover, Del., resident who now works in Baltimore as a nuclear medicine technologist, is pleased to see women are receiving more attention from the medical center.

"It wasn't a big priority before, but I'm glad to see they're catering more to the female side," she said.

The hospital is also opening a new radiation center, which Jain said will help streamline the breast care process. The center will allow eligible patients to receive radiation therapy, which prevents cancer recurrence, at the Baltimore VA rather than at another facility. Additionally, having a radiology clinician at the medical center enables women to receive consultations about the procedure before deciding on a treatment course.

"As we see more women, we have to acquire more resources," he said.

Jain noted that the rise in female veterans has also spurred the Baltimore VA to increase its advertising about treatment opportunities. He said the hospital has gotten the word out in newsletters and publications targeted at female veterans, at its women's clinics and at events.

Conroy, who has previously worked for the outreach and advocacy division of the Maryland Department of Veterans Affairs, applauded the hospital's campaign to attract more female patients. She has observed more women in the VA waiting rooms in recent years and female-friendly marketing.

Conroy said many women who spent time in the military don't necessarily think of themselves as veterans and don't always take advantage of opportunities afforded to them for their service.

"This isn't you taking a handout," she said. "This is something you earned."